Healthcare Provider Details

I. General information

NPI: 1033481643
Provider Name (Legal Business Name): LIFE THERAPEUTIC SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 ABBEY MILL DR SE
ADA MI
49301-7754
US

IV. Provider business mailing address

PO BOX 90002
WYOMING MI
49509-9919
US

V. Phone/Fax

Practice location:
  • Phone: 810-434-3339
  • Fax: 855-207-3270
Mailing address:
  • Phone: 810-434-3339
  • Fax: 855-207-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTINE KADING SCHWAB
Title or Position: ADMINISTRATOR/CONTRACTOR
Credential: CTRS, ATRIC
Phone: 810-434-3339